Regional Anesthetic and Analgesic Techniques for Clavicle Fractures and Clavicle Surgeries: Part 2—A Retrospective Study

Abstract

Objective. Clavicle fracture fixation is commonly performed under general anesthesia due to the complex sensory innervation in this region which poses a challenge for anesthesiologists applying regional anesthetic (RA) techniques. In part 1 of this two-part study, we summarized the current literature describing various RA approaches in clavicle fractures and surgery. In our earlier scoping review, we surmised that a superficial or intermediate cervical plexus block (CPB) may provide analgesia for this procedure and, when combined with an interscalene brachial plexus block (ISB), can provide anesthesia to the clavicular region for surgical fixation. We performed a retrospective study, consolidating assumptions that were based on the results of our earlier scoping review. Methods. A retrospective study was conducted on 168 consecutive patients who underwent clavicle fixation surgery at a tertiary healthcare system in Singapore. We used a standardized pro forma to collate perioperative data from the electronic health records of both hospitals, including anesthetic technique, analgesic requirements, pain scores, and adverse events, up to the second postoperative day or up until discharge. Results. In our study, patients who received RA had significantly reduced pain scores and opioid requirements, compared to general anesthesia (GA) alone. Through subgroup analysis, differences were found in postoperative pain scores and opioid requirements in the following order: GA alone > GA with local infiltration analgesia > CPB > CPB plus ISB. All patients who received combined CPB and ISB had upper limb weakness in recovery, compared to none with CPB alone (p < 0.001). Of those who received an ISB either in isolation or combined with a CPB, four (9.3%) were reported to have dyspnea (within 24 h) and motor weakness that persisted beyond 12 h, compared to none for patients that received CPB alone. Conclusions. Addition of a CPB to GA for clavicle fracture fixation surgery is associated with reduced pain scores in the early postoperative period, with a lower opioid requirement compared to GA alone. In patients undergoing GA, the combination of a CPB with an ISB was associated with a small, although statistically significant, reduction in pain scores and opioid requirements compared to a CPB alone.

Efficacy Comparison Between Interscalene Block with and Without Superficial Cervical Plexus Block for Anesthesia in Clavicle Surgery

“…The second group required less opioid medication and had a shorter stay in the PACU ( 16 ). Similarly, patients with clavicle fractures who received RA had less pain and consumed fewer opioids than those who received GA. Cervical and interscalene brachial plexus blocks resulted in minimal pain and opioid use ( 17 ).…”

Ultrasound-Guided Clavipectoral Fascial Plane Block as a Stand-Alone Anesthetic Technique for Clavicle Fracture Management: A Case Report

“…Clavicle fractures, which are frequently encountered in both the emergency department and the operating room, account for 2.6% of all fractures [ 1 ]. Providing regional anesthesia via peripheral nerve blocks can be a challenge to the anesthetist due to multiple innervations of the clavicle and the requirement of a combination of peripheral nerve blocks like cervical plexus block and brachial plexus block, which are associated with complications like phrenic nerve palsy and pneumothorax, respectively [ 2 ]. Hence, traditionally, general anesthesia has been the preferred anesthesia for clavicle fractures [ 3 ].…”